Facial Nerve Neuroma

1994 ◽  
Vol 73 (10) ◽  
pp. 721-752 ◽  
Author(s):  
Jack L. Pulec
Keyword(s):  
Facial Nerve ◽  
Signs And Symptoms ◽  
Middle Cranial Fossa ◽  
Nerve Graft ◽  
Surgical Removal ◽  
Optimal Conditions ◽  
Anatomic Site ◽  
Cranial Fossa ◽  
Slow Growing ◽  
Facial Function

Facial nerve neuromas are uncommon, slow-growing neoplasms that may occur anywhere along the course of the facial nerve from the brainstem to the facial muscles. The signs and symptoms are characteristic and vary with the anatomic site of origin. Surgery should not be attempted until a complete and thorough diagnostic examination has been completed. The surgeon should be prepared to perform a middle-cranial fossa or translabyrinthine approach in all cases, and must expect to do a nerve graft. The results of 37 patients treated by the author reveal that, under optimal conditions, patients who have had a facial nerve graft, can be expected to regain an average of 80 % facial nerve strength in almost every case. All patients who have had a facial nerve graft will have some degree of synkinesis. No graft was required in 3 patients, and a hypoglossal facial anastomosis was used for one. Facial function was completely normal in 2 patients, 16 had 80 – 90 % return, 5 patients had 50 – 80 % return, 4 had 20 – 50% return, one had no recovery at all and 9 recent patients have not reached the time for their expected recovery. Early diagnosis, prompt surgical removal and VII - VII Nerve graft for facial paralysis of ten or fewer years duration offers patients the best opportunity to avoid a permanent facial palsy.

Diagnosis and treatment of cavernous hemangioma of the internal auditory canal

2016 ◽  
Vol 124 (3) ◽  
pp. 639-646 ◽  
Author(s):  
Wei Dong Zhu ◽  
Qi Huang ◽  
Xi Ye Li ◽  
Hong Sai Chen ◽  
Zhao Yan Wang ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Cavernous Hemangioma ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Middle Cranial Fossa ◽  
Surgical Removal ◽  
Translabyrinthine Approach ◽  
History Of ◽  
Cranial Fossa

OBJECT Cavernous hemangioma of the internal auditory canal (IAC) is an extremely rare type of tumor, and only 50 cases have been reported in the literature prior to this study. The aim in this study was to describe the symptomatology, radiological features, and surgical outcomes for patients with cavernous hemangioma of the IAC and to discuss the diagnostic criteria and treatment strategy for the disease. METHODS The study included 6 patients with cavernous hemangioma of the IAC. All patients presented with sensorineural hearing loss and tinnitus, and 2 also suffered from vertigo. Five patients reported a history of facial symptoms with hemispasm or palsy: 3 had progressive facial weakness, 1 had a hemispasm, and 1 had a history of recovery from sudden facial paresis. All patients underwent CT and MRI to rule out intracanalicular vestibular schwannomas and facial nerve neuromas. Five patients had their tumors surgically removed, while 1 patient, who did not have facial problems, was followed up with a wait-and-scan approach. RESULTS All patients had a presurgical diagnosis of cavernous hemangioma of the IAC, which was confirmed pathologically in the 5 patients who underwent surgical removal of the tumor. The translabyrinthine approach was used to remove the tumor in 4 patients, while the middle cranial fossa approach was used in the 1 patient who still had functional hearing. Tumors adhered to cranial nerves VII and/or VIII and were difficult to dissect from nerve sheaths during surgeries. Complete hearing loss occurred in all 5 patients. In 3 patients, the facial nerve could not be separated from the tumor, and primary end-to-end anastomosis was performed. Intact facial nerve preservation was achieved in 2 patients. Patients were followed up for at least 1 year after treatment, and MRI showed no evidence of tumor regrowth. All patients experienced some level of recovery in facial nerve function. CONCLUSIONS Cavernous hemangioma of the IAC can be diagnosed preoperatively through analysis of clinical features and neuroimaging. Early surgical intervention may preserve the functional integrity of the facial nerve and provide a better outcome after nerve reconstruction. However, preservation of functional hearing may not be achieved, even with the retrosigmoid or middle cranial fossa approaches. The translabyrinthine approach seems to be the most appropriate approach overall, as the facial nerve can be easily located and reconstructed.

Facial Nerve Outcomes in Middle Cranial Fossa vs Translabyrinthine Approaches

2005 ◽  
Vol 133 (6) ◽  
pp. 906-910 ◽  
Author(s):  
Brandon Isaacson ◽  
Steven A. Telian ◽  
Hussam K. El-Kashlan
Keyword(s):  
Facial Nerve ◽  
Tertiary Care ◽  
Middle Cranial Fossa ◽  
Vestibular Schwannomas ◽  
Care Hospital ◽  
Case Review ◽  
Retrospective Case ◽  
Increased Risk ◽  
Significant Difference ◽  
Cranial Fossa

OBJECTIVE: To compare the final facial nerve outcomes between middle cranial fossa (MCF) vs translabyrinthine (TL) resection of size-matched vestibular schwannomas. STUDY DESIGN AND SETTING: Retrospective case review at a tertiary care hospital. All patients who underwent resection utilizing either MCF or TL approaches with tumors 18 mm or smaller and complete data were included in the analysis. One hundred twenty-four patients were identified meeting the above criteria, with sixty-three in the translabyrinthine group and sixty-one in the middle fossa group. One-week-postoperative and final facial nerve examinations were compared in the two surgical groups. Patients were separately analyzed in subgroups: tumors smaller than 10 mm and those that were between 10 and 18 mm. RESULTS: The tumor size range for the MCF group was 3-18 mm while it was 4-18 mm for the TL group. No statistically significant difference was found in facial nerve outcomes between the two surgical groups, at the first postoperative visit week and at last follow-up. CONCLUSION: Facial nerve outcomes are similar using TL and MCF approaches for resection of vestibular schwannomas up to 18 mm in size. SIGNIFICANCE: Patients undergoing the MCF approach for hearing preservation can be counseled that there is no increased risk of permanent facial nerve weakness, compared to the TL approach. EBM RATING: B-3

Facial Nerve Schwannoma Presenting as a Mass in the Middle Cranial Fossa: Typical Neuroradiological Patterns for a Preoperative Diagnosis

2008 ◽  
Vol 21 (5) ◽  
pp. 651-654
Author(s):  
M. De Simone ◽  
A. Bartolini ◽  
G. Esposito ◽  
G.M. Algieri ◽  
G. Catapano ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Preoperative Diagnosis ◽  
Clinical Presentation ◽  
Middle Cranial Fossa ◽  
Mri Findings ◽  
Neurogenic Tumour ◽  
Imaging Characteristics ◽  
Complete Work ◽  
Cranial Fossa ◽  
Facial Nerve Schwannoma

Facial nerve schwannoma is a rare primary neurogenic tumour that may originate anywhere along the VIIth nerve course. The clinical presentation is highly dependent on the location of the lesion along the nerve course and this makes the pre-operative diagnosis difficult without radiologic examination. The most common presentation is facial palsy and even though tumours are responsible for only 5% of facial palsies, if a patient does not recover within six months a complete work-up for neoplasm is recommended. On the basis of clinical presentation and imaging characteristics radiologists should try to make a preoperative diagnosis, to help in the patient's management and possibly to plan the surgical approach. We describe the case of a successful preoperative diagnosis of facial nerve schwannoma. The aim is to describe the main CT and MRI findings which may help the radiologist to establish a correct differential diagnosis.

scholarly journals Middle Fossa Approach for Resection of an Intracanalicular Vestibular Schwannoma

2019 ◽  
Vol 80 (S 03) ◽  
pp. S287-S287
Author(s):  
Walter C. Jean ◽  
Kyle Mueller ◽  
H. Jeffrey Kim
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Middle Cranial Fossa ◽  
Petrous Bone ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Nerve Preservation ◽  
Greater Superficial Petrosal Nerve ◽  
Cranial Fossa ◽  
Video Case Report

Objective This video was aimed to demonstrate the middle fossa approach for the resection of an intracanalicular vestibular schwannoma. Design Present study is a video case report. Setting The operative video is showing a microsurgical resection. Participant The patient was a 59-year-old man who presented with worsening headache and right-side hearing loss. He was found to have a right intracanalicular vestibular schwannoma. After weighing risks and benefits, he chose surgery to remove his tumor. Since his hearing remained “serviceable,” a middle fossa approach was chosen. Main Outcome Measures Pre- and postoperative patient photographs evaluated the muscles of facial expression as a marker for facial nerve preservation. Results A right middle fossa craniotomy was performed which allowed access to the floor of the middle cranial fossa. The greater superficial petrosal nerve (GSPN) and arcuate eminence were identified. Using these two landmarks, the internal acoustic canal (IAC) was localized. After drilling the petrous bone, the IAC was unroofed. The facial nerve was identified by stimulation and visual inspection and the tumor was separated from it with microsurgical dissection. In the end, the tumor was fully resected. Both the facial and cochlear nerves were preserved. Postoperatively, the patient experienced no facial palsy and his hearing is at baseline. Conclusion With radiosurgery gaining increasing popularity, patients with intracanalicular vestibular schwannomas are frequently treated with it, or are managed with observation. The middle fossa approach is therefore becoming a “lost art,” but as demonstrated in this video, remains an effective technique for tumor removal and nerve preservation.The link to the video can be found at: https://youtu.be/MD6o3DF6jYg.

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